Expression of tumor-associated vascular insulin receptor in colorectal cancer and its relationship with tumor pathological features / 浙江大学学报·医学版

OBJECTIVE@#To study the expression of tumor associated vascular insulin receptor (TVIR) in colorectal cancer with or without metabolic syndrome (MS) and its relationship with the pathological features of colorectal cancer.@*METHODS@#The expression of TVIR in 220 colorectal cancer specimens was detected by tissue microarray and immunohistochemistry. The relationships between the expression of TVIR and the pathological features (pathological subtypes, histological grade, invasion depth, lymph node metastasis and TNM stage) of colorectal cancer with/without MS were analyzed.@*RESULTS@#The insulin receptor expression was observed in colorectal cancer tissue or border area between cancer and normal tissue, but not in normal intestinal tissue. The high-expression rates of TVIR in MS group was remarkably lower than that of non-MS group (21.6%vs. 41.0%, @*CONCLUSIONS@#s: High-expression of TVIR is associated with aggressive pathological features such as invasion, lymph node metastasis and high TNM stage of colorectal cancer, especially for those patients without MS. TVIR could be a useful biological marker for prognosis of colorectal cancer.

Can an enhanced recovery after surgery (ERAS) programme improve colorectal cancer outcomes in South Africa?

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of cancer related deaths. It is estimated that CRC is amongst the top five malignancies in South Africa (SA) with an age standardised incidence rate of 10.2 and 6.1 per 100 000 for males and females respectively. The incidence is projected to increase in South Africa as a result of ageing, a growing population and an increase in prevalence of risk factors

Effects of zinc supplementation on fatigue and quality of life in patients with colorectal cancer / Efeitos da suplementação de zinco na fadiga e na qualidade de vida de pacientes com câncer colorretal

ABSTRACT Objective To investigate the effects of oral zinc supplementation on fatigue intensity and quality of life of patients during chemotherapy for colorectal cancer. Methods A prospective, randomized, double-blinded, placebo-controlled study was conducted with 24 patients on chemotherapy for colorectal adenocarcinoma in a tertiary care public hospital. The study patients received zinc capsules 35mg (Zinc Group, n=10) or placebo (Placebo Group, n=14) orally, twice daily (70mg/day), for 16 weeks, from the immediate postoperative period to the fourth chemotherapy cycle. Approximately 45 days after surgical resection of the tumor, all patients received a chemotherapeutic regimen. Before each of the four cycles of chemotherapy, the Functional Assessment of Chronic Illness Therapy-Fatigue scale was completed. We used a linear mixed model for longitudinal data for statistical analysis. Results The scores of quality of life and fatigue questionnaires were similar between the groups during the chemotherapy cycles. The Placebo Group presented worsening of quality of life and increased fatigue between the first and fourth cycles of chemotherapy, but there were no changes in the scores of quality of life or fatigue in the Zinc Group. Conclusion Zinc supplementation prevented fatigue and maintained quality of life of patients with colorectal cancer on chemotherapy.

RESUMO Objetivo Investigar os efeitos da suplementação oral de zinco sobre a intensidade da fadiga e a qualidade de vida de pacientes durante a quimioterapia para neoplasia colorretal. Métodos Estudo prospectivo, randomizado, controlado e duplo-cego conduzido em um hospital universitário público terciário, com 24 pacientes em regime quimioterápico para adenocarcinoma colorretal. Os pacientes receberam cápsulas de zinco 35mg (Grupo Zinco, n=10) ou placebo (Grupo Placebo, n=14) por via oral, duas vezes ao dia (70mg/dia), durante 16 semanas, desde o período pós-operatório imediato até o quarto ciclo de quimioterapia. Todos os pacientes receberam quimioterapia por aproximadamente 45 dias após a ressecção cirúrgica do tumor. A escala Functional Assessment of Chronic Illness Therapy-Fatigue foi preenchida antes de cada um dos quatro ciclos de quimioterapia. Utilizou-se o modelo de regressão linear misto para dados longitudinais para análise estatística. Resultados Os escores de qualidade de vida e de fadiga foram semelhantes entre os grupos de estudo durante os ciclos de quimioterapia. O Grupo Placebo apresentou piora da qualidade de vida e da fadiga entre o primeiro e o quarto ciclos de quimioterapia, mas não houve mudança nos escores de qualidade de vida e fadiga no Grupo Zinco. Conclusão A suplementação com zinco previne a fadiga e preserva a qualidade de vida de pacientes em quimioterapia para neoplasia colorretal.

Prognostic impact of the number of resected lymph node on survival in Colorectal Cancer / Impacto prognóstico do número de linfonodos ressectados na sobrevida de pacientes com câncer colorretal

Abstract Introduction Colorectal Cancer (CRC) is the third most common cancer and the second leading cause of death in Western countries. In Portugal, in the North, emerges as the second most common cancer. The presence of lymph node metastasis is an important predictor of overall and disease-free survival and several studies recommend the evaluation of at least 12-14 regional lymph nodes, as it contributes to improve cancer staging and patient outcomes. Aims Epidemiological characterization of the studied population and identify a possible relationship between the number of lymph nodes evaluated in the surgical specimen and survival. Methods We preceded to the study of 1065 CCR patients, submitted to surgical resection between 1 January 2000 and 31 August 2012, in Braga Hospital. Discussion/Conclusion The results of the epidemiological characterization of this population are coincident with those described in the literature. It was observed a significant correlation between age, tumor size, serosal invasion, differentiation, tumor penetration, venous and lymphatic invasion, metastasis, TNM stage and the number of lymph nodes evaluated. However, we did not observe a statistically significant correlation between patient survival and number of lymph nodes evaluated (p > 0.05). A possible explanation is the practice of oncologists, addressing patients with less than 12 nodes identified in the surgical specimen as "N-positive" and undergoing adjuvant therapy. A better harvest and careful analysis of lymph nodes would lead to more accurate staging, avoiding overtreatment and side effects associated, and allow better economic management of hospital resources, in real N0 patients.

Resumo Introdução O câncer colorretal (CCR) ocupa o terceiro lugar em termos de frequência e, além disso, é a segunda causa principal de morte nos países ocidentais. Em Portugal, no norte, CCR surge como o segundo câncer mais comum. A presença de metástase aos linfonodos é preditor importante de sobrevida em geral e de sobrevida livre da doença; vários estudos recomendam a avaliação de pelo menos 12-14 linfonodos regionais, pois tal procedimento contribui para aprimorar o estadiamento do câncer e os desfechos para os pacientes. Objetivos Caracterização epidemiológica da população estudada e identificação de possível relação entre o número de linfonodos avaliados no espécime cirúrgico e sobrevida. Métodos Estudo de 1065 pacientes com CCR, submetidos à ressecção cirúrgica entre 1 de janeiro de 2000 e 31 de agosto de 2012 em um hospital em Braga. Discussão/Conclusão Os resultados da caracterização epidemiológica dessa população coincidem com os resultados descritos na literatura. Foi observada uma correlação significativa entre idade, tamanho do tumor, invasão da serosa, diferenciação, penetração tumoral, invasão venosa e linfática, metástase, estágio TNM e número de linfonodos avaliados. Mas não observamos uma correlação estatisticamente significativa entre sobrevida do paciente e número de linfonodos avaliados (p > 0,05). Uma explicação possível é a prática dos oncologistas, que tratam pacientes com menos de 12 nodos identificados no espécime cirúrgico como "N-positivos", prosseguindo com terapia adjuvante. Uma coleta mais apropriada e uma análise cuidadosa dos linfonodos resultaria em um estadiamento mais preciso, evitando o tratamento excessivo e os efeitos colaterais associados, além de permitir um tratamento com melhor custo-benefício para os recursos hospitalares em pacientes realmente N0.

Conocimiento de médicos de un Hospital Universitario de Buenos Aires respecto de las recomendaciones de vigilancia colonoscópica luego del hallazgo de un pólipo colónico: estudio de corte transversal / Knowledge of physician that work in a University Hospital of Buenos Aires about the recommendations of colonoscopic surveillance after the discovery of a colonic polyp: cross sectional study

Antecedentes: los pacientes con pólipos colónicos suelen ser sobre vigilados, lo que los expone a riesgos innecesarios y aumenta las dificultades para satisfacer las demandas genuinas de dicha prestación. Objetivo: documentar el conocimiento sobre recomendaciones de vigilancia colonoscópica en un Hospital Universitario Privado de Buenos Aires. Material y métodos: estudio de corte transversal a través de un cuestionario autoadministrado con varios escenarios clínicos. Fueron invitados todos los profesionales con alta carga de atención programada y todos los residentes de medicina familiar y comunitaria (n=94; tasa de respuesta75,5%).Resultados: predominó el error por sobre vigilancia (20% para pólipos hiperplásicos; 47% para adenomas tubulares de 6mm sin displasia y56% para un adenoma tubular de 12 mm con un foco de displasia de alto grado).Conclusiones: las respuestas fueron mejores que las reportadas por la bibliografía, con predominio del error por sobre vigilancia.

Background: Patients with colonic polyps usually oversurveilled over-monitored, which exposes them to unnecessary risks and increases the difficulties to meet the genuine demands of colonoscopyt. Objective: To document the knowledge about current recommendations of colonoscopic surveillance in a University Associated Private Hospital in Buenos Aires. Methods: cross-sectional study through a self-administered questionnaire with several clinical scenarios. All professionals with a high burden of scheduled care and all family medicine residents were invited (n = 94, response rate: 75.5%). Results: over-surveillance error predominated (20% for hyperplastic polyps, 47% for a 6mm tubular adenomas without dysplasia and 56% for a 12 mm tubular adenoma with a focus of high-grade dysplasia). Conclusions: The responses were better than those reported in the literature. Over-surveillance error was the most frecuently documentated.

Morphology of Colorectal Carcinoma among Nigerians: A 30-Year Review

Background: The incidence of colorectal carcinoma has been on the increase in the developing countries; including Nigeria; as a result of change in diet and adoption of western lifestyle. Objectives: The aim of this review is to highlight the prevalence; age and sex distribution; anatomical location; and morphological characteristics of colorectal carcinomas in Ilorin; Nigeria. Materials and Methods: This is a retrospective study of all cases of histologically diagnosed colorectal carcinoma in the University of Ilorin Teaching Hospital; Ilorin; Nigeria; over a 30-year period (January 1979-December 2008); using the departmental record and histological slides of the cases. Result: A total of 241 cases of colorectal carcinoma were reported; 144 cases (60) in males and 96 cases (40) in females with a male: female ratio of 1.5:1. The peak age of occurrence for males was between 51 and 60 years; while that of the females was between 41 and 50 years. The malignancy was found in the rectum in 60.2of the cases; while the least affected site is the descending colon (1.2). The exophytic occluding masses were found in 82.2of the cases; and the most common histological type is adenocarcinoma (77.2) with well-; moderately; and poorly differentiated forms constituting 52.3; 32.8; and 14.9respectively. Of the 241 cases that were seen over the last 30 years; 93 cases (38.6) were seen in the last 5 years. Conclusion: Colorectal carcinoma is no longer a rare disease in Nigeria. The surge in the incidence reported in the last 5 years in this center calls for a pragmatic action in its control; with emphasize on colonoscopic screening for those with family history; and possibly making digital rectal examination a mandatory aspect of clinical examination; because most colorectal carcinomas are within the reach of examining finger

Linfoma de células del manto: manifestación extranodal colorrectal / Mantle-cell lymphoma: extranodal manifestation colorectal

Antecedentes: Los linfomas gastrointestinales agrupan diferentes lesiones y son objeto de permanente revisión. Se los considera de acuerdo a su histología y el estadio evolutivo, hechos que suelen guardar estrecha relación con la clínica, las conductas terapéuticas y el pronóstico. El tubo digestivo está afectado entre un 5 a 15 por ciento en los pacientes que padecen Linfoma no Hodking. El colon y recto son los sitios de menor frecuencia. Representa entre 0,2 a 0,6 por ciento de los tumores malignos colorrectales. El linfoma de células del manto es un subtipo de linfoma de células B, con una frecuencia del 5 al 10 por ciento dentro de los linfomas no Hodking. Objetivo: Presentar el caso de una manifestación colorrectal de linfoma de células del manto, sus características fisiopatológicas y sus alternativas terapéuticas. Pacientes y método: Paciente de 82 años consultó por proctorragia, diarrea crónica, pérdida de peso y mucorrea de más de tres meses de evolución. Se realizó videocolonoscopía constatándose a 10 cm del margen anal lesión mamelonada, friable, ulcerovegetante, extendida hasta sigma con múltiples pólipos sesiles y subpediculados de gran tamaño en cantidad mayor de 100, extendidos en todo el colon. El hallazgo en correlación con la clínica y la endoscopia es compatible con linfoma de células del manto en su forma de afectación extranodal gastrointestinal, y poliposis linfomatosa múltiple. Resultados: Se realizó seis esquemas de quimioterapia bajo la modalidad CHOOP (ciclofosfamida, doxirrubicina, vincristina, prednisona) conjuntamente la aplicación al comienzo de los ciclos con Rituximab (Anticuerpo monoclonal). Se realizó un control endoscópico y tomográfico demostrando remisión completa del compromiso colorrectal, ganglios mesentéricos y retroperitoneales. Se observó persistencia de masas mediastinicas intercavo-aorticas derrame pleural bilateral y dilatación cardiaca...

Background: Gastrointestinal Lymphomas different injuries and are grouped under constant review. They are considered according to their histology and stage of development, events that are closely related to the clinic, the therapeutic behavior and prognosis. The gastrointestinal tract is affected between 5 to 15 per cent in patients with non-Hodgkin lymphoma. The colon and rectum are less frequent sites. It represents between 0.2 and 0.6 per cent of malignant colorectal tumors. The mantle cell lymphoma is a subtype of B-cell lymphoma, with a frequency of 5 to 10 per cent in non-Hodgkin lymphoma. Objective: To present the case of a manifestation colorectal mantle cell lymphoma, pathophysiological characteristics and treatment options. Patients and methods: Patient 82 years consulting with bloody diarrhea, chronic diarrhea, weight loss and mucorrea more than three months of evolution. A colonoscopy was performed, confirmed a 10 cm from the anal injury swellings, extended to multi-sigma subpediculados sessile polyps and large in quantity greater than 100, spread throughout the colon. The finding in correlation with clinical and endoscopy is compatible with mantle cell lymphoma, as extranodal gastrointestinal involvement and multiple lymphomatous polyposis. Results: we performed six schemes in the form CHOOP chemotherapy (cyclophosphamide, doxirrubicina, vincristine, prednisone) combined the application at the beginning of the cycles with Rituximab (monoclonal antibody). We undertook a endoscopy and CT demonstrated complete remission of colorectal disease, commitment, mesenteric and retroperitoneal lymph nodes. Showed persistence of mediastinal masses, bilateral pleural effusion and cardiac dilatation. Today is free from colorectal disease and active monitoring by their serial mediastinal and their heart failure...

Cancer of the colon and rectum in a Jamaican population: diagnostic implications of the changing frequency and subsite distribution

The aim of this study was to examine the clinical and pathological characteristics of colorectal cancer in Jamaica, to determine whether there was a change in the anatomic distribution and clinical presentation and to discuss the options for diagnosis and management. A comprehensive retrospective review of patients newly diagnosed with colorectal carcinoma was conducted at The University Hospital of the West Indies by reviewing both patient records and pathological data. These data were compared with previous reports of patients with colorectal cancer seen in Jamaica. One hundred and forty-seven patients were studied There were 85 females and 62 males with a female to male ratio of 1.37:1. The median age was 65.5 years (range 19 to 94 years). The predominant symptoms were abdominal pain in 91 patients, change in bowel habit in 77 patients and rectal bleeding in 74 patients. Sixty patients presented with weight loss and 28 with a rectal mass. The most common tumours were right-sided colonic cancers in 42 patients (28.5) followed by sigmoid colon in 30 (20.4) rectum in 34 (23.1) and left and transverse colon accounting for 16 and 10 cases respectively. Most of the tumours were well or moderately differentiated adenocarcinomas. Only eight patients presented with Dukes' A disease, 50 with Dukes'B, 53 with Dukes'C disease and 34 with advanced disease. The findings showed that sigmoid and rectal tumours accounted for 43.5 of cancers. The colon/rectum ratio in this series was 3.3:1 indicating a significant proximal shift of colorectal cancers in this population in keeping with recent reports. The results of the current study suggest that the sub-site location of colorectal cancers seen is similar to that reported in high incidence countries such as the United States of America and parts of Europe but differs from the African continent which has a high proportion of rectal tumours. This right-sided preponderance also differs from previous studies in Jamaica, which report a higher incidence of rectal lesions The detection of early colorectal carcinoma will require screening at a stage when the disease is asymptomatic in order to improve the chance for cure. The data presented here imply that screening programmes should allow evaluation of the entire colon rather than the distal 25 cm

Câncer colorretal / Colorectal neoplasms

Os autores revisam o conhecimento atual sobre os aspectos clínicos e epidemiológicos do câncer colorretal com ênfase especial na prevenção, rastreamento e avanços terapêuticos desta doença

Angiogênese no carcinoma colorretal - revisäo e perspectivas / Colorectal carcinoma angiogenisis - review and perspectives

Em adiçäo aos sistemas de estadiamento clinicopatológicos comumente utilizados, fatores de risco para a recorrência no carcinoma colorretal têm sido investigados. Entre estes a quantificaçäo da angiogênese e de peptídeos angiogênicos têm demonstrado aplicaçäo clínica na avaliaçäo da sobrevida e recorrência. A angiogênese é o crescimento de novos capilares, estando associada tanto ao desenvolvimento tecidual pré e pós-natal, cicatrizaçäo e reproduçäo como em doenças inflamatórias e neoplasias. Além de permitir o crescimento tumoral, evidências experimentais demonstram que a angiogênese associa-se com o processo metastático, pois maior é a superfície vascular para o escape de células neoplásicas, o que também pode ser facilitado pela imaturidade dos novos vasos. Neste artigo de revisäo discute-se o processo de formaçäo de vasos capilares, associado ao crescimento tumoral e ao surgimento de metástases hematogênicas, bem como uma revisäo de literatura abordando angiogênese e carcinoma colorretal e o seu papel como um possível alvo terapêutico

Topographic expression of p21WAF1/SDI1/CIP1, bcl2, and p53 is altered at the early stage of colorectal carcinogenesis

We analyzed the expression of p21, bcl2, and p53 in normal and different pathologic mucosa of the human colorectum using immunohistochemistry and cold polymerase chain reaction-single strand conformation polymorphism. The topography of normal mucosa showed; bcl2 and p53 expression restricted to basal epithelial cells and p21 expressed only in superficial epithelial cells. This topographic expression was altered in hyperplastic polyps and adenomas. Hyperplastic polyps revealed absence of or weak bcl2 expression and strong p21 expression without topography. In adenomas, whereas bcl2 expression increased and extended to parabasal and superficial dysplastic epithelium, the increase of p21 expression was limited to surface dysplastic epithelium. p53 was weakly expressed throughout the full thickness of dysplastic epithelium. Bcl2 expression in adenomas was stronger than in carcinomas; p53 expression was converse and p21 expression was variable. In carcinomas, this topographic expression was largely abrogated but p53 mutation (36%) was more frequent than in adenomas (2%). In carcinomas, p21 and p53 expression correlated inversely, but there was no relationship with bcl2. These results suggest that there is precisely ordered topographic pattern of p21, bcl2, and wild p53 expression in normal colorectal cells, but this becomes disordered during the early stage of colorectal carcinogenesis.

Angiogénesis en el carcinoma del colon y del recto / Angiogenesis in colo-rectal carcinoma

Objetivo: Investigar la angiogénesis, uno de los factores involucrados en el desarrollo neoplásico y analizar su relación fisiopatogénica en el carcinoma del colon y del recto. Lugar de aplicación: Hospital Español de Buenos Aires. Diseño: Estudio retrospectivo y descriptivo. Población: 43 pacientes operados por carcinoma del colon y del recto, entre Enero de 1995 y Diciembre de 1997. De ellos, 29 eran del sexo femenino y 15 del masculino. Edad promedio 71 años, con rango de 34 a 92 años. Método: Se efectuaron cortes histológicos de los tumores que fueron teñidos con anticuerpos monoclonales anti CD 31, anti CD 34 y policlonal factor VIII o de von Willebrand. Se analizó la densidad de la microvasculatura (DMC) y se la correlacionó con el grado histológico, la presencia de ganlios metastásicos, el tamaño y la estadificación tumoral. Para la estadificación se utilizó la clasificación de Dukes modificándola con el agregado de la letra "D" cuando hubo diseminación a distancia. Resultados: 2 pacientes tenían estadio A, 19 estadio B, 18 estadio C y 4 estadio D. Hubo correlación estadísticamente significativa entre la angiogénesis y las adenopatías metastásicas (CD 31 p=0.006; CD 34 p=0.0002 y FVIII p=0.00008) y con la diferenciación histológica (CD 31 p- 0.00008; CD 34 p= 0.000002 y F VIII p=0.005). No hubo correlación estadísticamente significativa con el tamaño tumoral ni con la estadificación de las neoplasias. Conclusiones: La presencia de metástasis ganglionares y el grado de diferenciación tumoral se correlacionaron con una mayor densidad de la microvasculatura, lo que sugiere la importancia de la angiogénesis en la fisiopatogenia del carcinoma colorrectal.

Mecanismos de diseminación y tratamiento de las metástasis ováricas de adenocarcinoma de colon / Spread mechanisms and treatment of ovarian metastasis from adenocarcinoma of the colon

OBJETIVOS: 1) Conocer la frecuencia de las metástasis ováricas en nuestra población con cáncer colorrectal; 2) definir el papel del tratamiento quirúrgico, y 3) determinar los mecanismos de diseminación del cáncer del colon a los ovarios. MATERIAL Y METODOS: Entre 1989 y 1993, atendimos 624 pacientes con cáncer colorrectal; de éstos, 19 (7.7 por ciento) tuvieron metástasis al ovario y fueron divididos en 2 grupos de acuerdo con el tiempo del diagnóstico. El grupo A incluyó a los pacientes con metástasis sincrónicas y el B metástasis metacrónicas. A 17 pacientes se les realizó lavado peritoneal. El tumor primario se trató con cirugía. RESULTADOS: El promedio de edad en el grupo total fue de 41.4 años. El grupo A con 9 pacientes; 3 fueron operadas en forma electiva y 6 de urgencia. En 8 pacientes el tumor primario se localizó en el sigmoides y en una en el ciego. Los tumores se etapificaron como: B1, 2; B2, 3; C2, 4. Las metástasis se localizaron en el ovario izquierdo en 6, en el derecho en 2 y en ambos en 1. El lavado peritoneal fue positivo en 6 y negativo en 3. el grupo B: 10 pacientes; una se operó en forma electiva y 9 de urgencia. Los tumores primarios se localizaron 9 en el sigmoides y 1 en el ciego y se etapificaron como: B2, 4; C2, 4; D, 2. Las metástasis se encontraron en el ovario izquierdo en 5, en el derecho 1 y en ambos 4. El lavado peritoneal fue positivo en 6; negativo en 2 y no se efectuó en 2. La supervivencia a 5 años en el grupo A fue de 16 por ciento en el B. CONCLUSIONES: Las metástasis ováricas están asociadas a enfermedad diseminada. El tratamiento de las metástasis sincrónicas es la excisión del tumor primario más salpingooferectomía bilateral y el de las metacrónicas sólo es paliativo. El mecanismo de diseminación es mixto y puede ser por implantación directa y hematógeno